Application Form

InwardBound 3 Day Private Retreat Programme: 1 Psilocybin Session - Netherlands / Costa Rica

Open Dates
- With Rob Ó Cobhthaigh (Psychotherapist), Dr. Darragh Stewart Phd, Renee Hendriks, Sophie-Charlotte Adler (M.Sc.), Dr Lauretta Greer Phd (Psychologist) and Maryna Zagorodnia (Psychotherapist)

Please do not fill in this application form until you have booked an initial consultation call viaadmin@inwardbound.ie.

Please take your time in completing this application form. The information you supply is treated with the strictest confidence.

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1 Accommodation Options

Select a price.
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€4,499.00 – Group experience - Private group 3-day Retreat Programme (3+ Participants, price per person VAT Included)
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€6,499.00 – Shared Journey 3-day Retreat Programme (2 Participants, price per person VAT Included)
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€7,999.00 – Private 3-day Retreat Programme (Single Participant VAT Included)

2 People in your group

Guest 1
First Name*
Last Name*
Email*
Gender*
Guest 1
First Name*
Last Name*
Email*
Gender*

3 Optional Items

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4 Participant Info

Please take your time in completing this Pre-Screening Questionnaire. It is for your own safety that we require you to disclose as much detail about your medical history as possible. The information you supply is treated with the strictest confidence refer to Privacy Policy and ToS. We will do our best to accommodate Participants on InwardBound Retreats - subject to our Terms and Conditions. Please book an exploration call via admin@inwardbound.ie before filling in this application form to make sure you are a suitable candidate. InwardBound reserve the right to refuse participation if the safety or Participants may be compromised. Please provide all information that you feel is relevant. If you have any questions, please email admin@inwardbound.ie Any Participant who provides incorrect information or obscured details, may be endangering themselves and others and can be expelled from the retreat without question and without refund at the sole discretion of the Organiser. Once completed we will screen it and send on our full screening form and book you in for your consultation screening and preparation call.
Why do you want to attend an InwardBound psychedelic therapy programme?
Medications Please fill out this section of the form thoroughly. This retreat involves ingesting psilocybin, a drug that can interact dangerously with some other substances. The list below is not exhaustive, therefore it is imperative that you list all currently and recently used substances.
If you answered "yes" to any of the above medical conditions, please give relevant details here. Please be as specific as possible, letting us know when you came off the above medication and if you are currently on the above medication.

5 Retreat Preferences

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6 Medical History

Please read the terms and conditions
Supplementary Products Exclusion: Participants acknowledge and agree that these Fees presented and payable pertain solely to Services and Offerings, and will not include the cost of any plant-medicines or similar products (collectively, "Supplementary Products") which may be provided, offered, or distributed by a Commercial User, or any other party, in connection with Services or Offerings. Retreat Guru shall bear no responsibility or liability in connection with any provision, offering, or distribution of Supplementary Products, and is not a party thereto. All capitalized terms used herein shall carry the same meaning as assigned to them in Retreat Guru's Terms of Service.

7 Security Check

8 Payment

Payments made through Retreat Guru do not include the cost of: plant medicine, psychedelics or similar products
Separate payment of €75.00 per person to be arranged with the center.
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